腹外斜肌转移肌瓣技术修补腹直肌缺失的临床应用

Clinical application of externus oblique abdominis pedicle flap graft technique in repair of rectus abdominis deficiency

目的探讨肿瘤或外伤等导致腹直肌缺失的患者使用腹外斜肌转移肌瓣技术行腹壁缺损修补和重建的临床应用效果。方法2014年12月至2018年12月,浙江大学医学院附属杭州市第一人民医院收治腹直肌缺失患者10例,采用腹外斜肌转移肌瓣技术进行腹壁缺损修补和重建。收集并回顾性分析患者的临床资料。通过问诊、查体和腹壁CT检查评估患者腹壁重建和恢复情况。结果10例腹直肌缺失患者中,腹直肌肿瘤9例(其中男性1例,女性8例),腹直肌外伤毁损1例(男性)。平均年龄(46.90±13.25)岁,体质量指数(23.10±3.98)kg/m^2。9例腹直肌肿瘤中,原发性肿瘤8例,转移性肿瘤1例,均行腹直肌复合体屏障性切除。腹直肌外伤患者行毁损腹直肌切除。切除后腹壁缺损平均宽度为(11.70±1.89)cm,均采用单侧腹外斜肌转移肌瓣技术进行腹壁缺损修补和功能重建,并采用补片加强修补。补片均为聚丙烯补片,平均大小为(420.00±154.91)cm^2。平均手术时间(132.50±38.96)min,平均术中出血量(107.00±74.54)ml,平均住院时间(11.50±4.30)d。术后无腹外斜肌肌瓣缺血坏死,无切口裂开、手术部位感染、肠瘘等并发症。在术后随访行问诊、体格检查及腹壁CT检查,显示患者腹壁完整,功能恢复良好。平均随访时间(35.50±11.35)个月,随访期内未发现肿瘤复发、切口疝形成或腹壁膨出病例。结论腹外斜肌转移肌瓣修补技术是一种安全有效腹壁缺损修补技术,在腹直肌缺失患者中具有较好的临床效果。

Objective To investigate the clinical application of abdominal wall defect repair and reconstruction with external oblique abdominis flap graft in patients with rectus abdominis deficiency caused by tumors or trauma.Methods 10 patients with rectus abdominis deficiency were admitted to Affiliated Hangzhou first people's hospital from December 2014 to December 2018.The abdominal wall defect was repaired and reconstructed with the technique of external oblique abdominis flap graft.The clinical data were collected and retrospectively analyzed.The reconstruction and recovery of abdominal wall were evaluated by inquiry,physical examination and abdominal wall CT examination.Results Among the 10 patients with rectus abdominis deficiency,9 were rectus abdominis tumors(8 females and 1 male),and 1 was rectus abdominis trauma(male).The average age was(46.90±13.25)years,and the mean BMI was(23.10±3.98)kg/m^2.Of the 9 rectus abdominis tumors,8 were primary tumors and 1 was metastatic tumors,all of which underwent barrier resection of rectus abdominis complex.Patients with rectus abdominis trauma underwent resection of injured rectus abdominis.The average width of abdominal wall defect after resection was(11.70±1.89)cm.Unilateral oblique abdominis flap graft were used to repair and reconstruct the abdominal wall defect with mesh for reinforcement.All meshes were polypropylene meshes with an average size of(420.00±154.91)cm^2.The average operation time was(132.50±38.96)minutes,the average intraoperative bleeding volume was(107.00±74.54)cm3,and the average hospitalization time was(11.50±4.30)days.There was no ischemic necrosis of abdominal external oblique muscle flap graft,no incision dehiscence,SSI,intestinal fistula and other complications.Follow-up examination,physical examination and abdominal wall CT showed that the abdominal wall was intact and the function recovered well.The average follow-up time was(35.50±11.35)months.No recurrence of tumors,incisional hernia or abdominal wall bulging were found during the follow-up.Conclusion External oblique abdominis flap graft technique is a safe and effective technique for repairing abdominal wall defect.It has a good clinical effect in patients with rectus abdominis deficiency.